Imaging and patient-specific simulations for the Fontan surgery: Current methodologies and clinical applications

Zélicourt, Diane de; Marsden, Alison L.; Fogel, Mark A.; Yoganathan, Ajit P.

doi:10.1016/j.ppedcard.2010.09.005

Cited by 35 publications

(38 citation statements)

References 100 publications

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“…In addition, advances in computational models have led to the development of more physiologically realistic patient-specific simulations. 24 Computational modeling has indicated that TCPC energy loss inversely correlates with decreased diameter of the TCPC conduit and pulmonary artery. These simulations also found correlations between hepatic flow distribution and caval offset, pulmonary flow distribution, and the connection angle between the TCPC and SVC.…”

Section: Discussionmentioning

confidence: 99%

Preclinical study of patient-specific cell-free nanofiber tissue-engineered vascular grafts using 3-dimensional printing in a sheep model

Fukunishi

Best

Sugiura

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

101

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Background Tissue-engineered vascular grafts (TEVGs) offer potential to overcome limitations of current approaches for reconstruction in congenital heart disease by providing biodegradable scaffolds on which autologous cells proliferate and provide physiologic functionality. However, current TEVGs do not address the diverse anatomic requirements of individual patients. This study explores the feasibility of creating patient-specific TEVGs by combining 3-dimensional (3D) printing and electrospinning technology. Methods An electrospinning mandrel was 3D-printed after computer-aided design based on preoperative imaging of the ovine thoracic inferior vena cava (IVC). TEVG scaffolds were then electrospun around the 3D-printed mandrel. Six patient-specific TEVGs were implanted as cell-free IVC interposition conduits in a sheep model and explanted after 6 months for histologic, biochemical, and biomechanical evaluation. Results All sheep survived without complications, and all grafts were patent without aneurysm formation or ectopic calcification. Serial angiography revealed significant decreases in TEVG pressure gradients between 3 and 6 months as the grafts remodeled. At explant, the nanofiber scaffold was nearly completely resorbed and the TEVG showed similar mechanical properties to that of native IVC. Histological analysis demonstrated an organized smooth muscle cell layer, extracellular matrix deposition, and endothelialization. No significant difference in elastin and collagen content between the TEVG and native IVC was identified. There was a significant positive correlation between wall thickness and CD68+ macrophage infiltration into the TEVG. Conclusions Creation of patient-specific nanofiber TEVGs by combining electrospinning and 3D printing is a feasible technology as future clinical option. Further preclinical studies involving more complex anatomical shapes are warranted.

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Section: Discussionmentioning

confidence: 99%

Preclinical study of patient-specific cell-free nanofiber tissue-engineered vascular grafts using 3-dimensional printing in a sheep model

Fukunishi

Best

Sugiura

et al. 2017

The Journal of Thoracic and Cardiovascular Surgery

101

View full text Add to dashboard Cite

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“…Several groups have used CFD to demonstrate the geometry’s role in TCPC hemodynamics (Dasi et al, 2009; Figliola et al, 2010; Kim et al, 1995; Sharma et al, 1996). Advances in computational power and medical imaging have allowed implementation of patient-specific data (de Zélicourt et al, 2010). There are still limitations in extending findings from numerical simulations to predicting long-term outcomes in TCPC patients (Dasi et al, 2009; Dasi et al, 2008; de Zélicourt et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Advances in computational power and medical imaging have allowed implementation of patient-specific data (de Zélicourt et al, 2010). There are still limitations in extending findings from numerical simulations to predicting long-term outcomes in TCPC patients (Dasi et al, 2009; Dasi et al, 2008; de Zélicourt et al, 2010). …”

Section: Discussionmentioning

confidence: 99%

Hemodynamic study of TCPC using in vivo and in vitro 4D Flow MRI and numerical simulation

Roldán‐Alzate

García-Rodríguez

Anagnostopoulos

et al. 2015

Journal of Biomechanics

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Altered total cavopulmonary connection (TCPC) hemodynamics can cause long-term complications. Patient-specific anatomy hinders generalized solutions. 4D Flow MRI allows in vivo assessment, but not predictions under varying conditions and surgical approaches. Computational fluid dynamics (CFD) improves understanding and explores varying physiological conditions. This study investigated a combination of 4D Flow MRI and CFD to assess TCPC hemodynamics, accompanied with in vitro measurements as CFD validation. 4D Flow MRI was performed in extracardiac and atriopulmonary TCPC subjects. Data was processed for visualization and quantification of velocity and flow. Three-dimensional (3D) geometries were generated from angiography scans and used for CFD and physical model construction through additive manufacturing. These models were connected to a perfusion system, circulating water through the vena cavae and exiting through the pulmonary arteries at two flow rates. Models underwent 4D Flow MRI and image processing. CFD simulated the in vitro system, applying two different inlet conditions from in vitro 4D Flow MRI measurements; no-slip was implemented at rigid walls. Velocity and flow were obtained and analyzed. The three approaches showed similar velocities, increasing proportionally with high inflow. Atriopulmonary TCPC presented higher vorticity compared to extracardiac at both inflow rates. Increased inflow balanced flow distribution in both TCPC cases. Atriopulmonary IVC flow participated in atrium recirculation, contributing to RPA outflow; at baseline, IVC flow preferentially travelled through the LPA. The combination of patient-specific in vitro and CFD allows hemodynamic parameter control, impossible in vivo. Physical models serve as CFD verification and fine-tuning tools.

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“…Below, we highlight recent contributions in all three stages of single ventricle repair. Several recent reviews provide an overview of modeling techniques in single ventricle physiology[42–44] as well as recent clinical guidelines. [45,46]…”

Section: Single Ventriclesmentioning

confidence: 99%

Computational modeling and engineering in pediatric and congenital heart disease

Marsden¹,

Feinstein

2015

Current Opinion in Pediatrics

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Purpose of review Recent methodological advances in computational simulations are enabling increasingly realistic simulations of hemodynamics and physiology, driving increased clinical utility. We review recent developments in the use of computational simulations in pediatric and congenital heart disease, describe the clinical impact in modeling in single ventricle patients, and provide an overview of emerging areas. Recent Findings Multiscale modeling combining patient specific hemodynamics with reduced order (i.e. mathematically and computationally simplified) circulatory models has become the defacto standard for modeling local hemodynamics and “global” circulatory physiology. We review recent advances that have enabled faster solutions, discuss new methods, (e.g. fluid structure interaction and uncertainty quantification), which lend realism both computationally and clinically to results, highlight novel computationally-derived surgical methods for single ventricle patients, and discuss areas in which modeling has begun to exert its influence including Kawasaki disease, fetal circulation, tetralogy of Fallot, (and pulmonary tree), and circulatory support. Summary Computational modeling is emerging as a crucial tool for clinical decision-making and evaluation of novel surgical methods and interventions in pediatric cardiology and beyond. Continued development of modeling methods, with an eye towards clinical needs, will enable clinical adoption in a wide range of pediatric and congenital heart diseases.

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Imaging and patient-specific simulations for the Fontan surgery: Current methodologies and clinical applications

Cited by 35 publications

References 100 publications

Preclinical study of patient-specific cell-free nanofiber tissue-engineered vascular grafts using 3-dimensional printing in a sheep model

Preclinical study of patient-specific cell-free nanofiber tissue-engineered vascular grafts using 3-dimensional printing in a sheep model

Hemodynamic study of TCPC using in vivo and in vitro 4D Flow MRI and numerical simulation

Computational modeling and engineering in pediatric and congenital heart disease

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